PeerNaija: A Mobile Health Platform Incentivizing Medication Adherence Among Youth Living with HIV in Nigeria

PeerNaija：一个移动医疗平台，激励尼日利亚艾滋病毒感染者坚持用药

• 批准号: 10055813
• 负责人: Aimalohi Ahonkhai
• 金额: $ 1.6万
• 依托单位: VANDERBILT UNIVERSITY MEDICAL CENTER
• 依托单位国家: 美国
• 财政年份: 2019
• 资助国家: 美国
• 起止时间: 2019-09-26 至 2021-04-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10055813
• 关键词: Acquired Immunodeficiency Syndrome; Adherence; Adolescence; Adolescent; Adolescent and Young Adult; Adoption; Adult; Africa; Africa South of the Sahara; African; Attitude; Behavior; Behavior Therapy; Car Phone; Caring; Cause of Death; Cellular Phone; Cessation of life; Clinic; Clinical; Collaborations; Communication; Communities; Competence; Continuity of Patient Care; Data; Development; Failure; Focus Groups; Funding; Future; HIV; HIV Infections; HIV-infected adolescents; Health; Health Promotion; Health Technology; Health behavior; Impulsivity; Incentives; Individual; Infrastructure; Intervention; Intervention Trial; Interview; Left; Literature; Measures; Medical; Mobile Health Application; Monitor; Morbidity - disease rate; Nigeria; Nigerian; Nongovernmental Organizations; Outcome; Ownership; Patients; Persons; Pharmaceutical Preparations; Play; Population; Prize; Psychological reinforcement; Public Health; Research; Research Methodology; Research Personnel; Resources; Risk-Taking; Role; Services; Site; Solid; Technology; Thinking; Work; Youth; age group; antiretroviral therapy; base; cohort; contagion; digital; disease transmission; financial incentive; global health; high risk; implementation research; implementation science; improved; informant; innovation; mHealth; medication compliance; mortality; novel; patient population; peer; peer influence; peer support; prevent; programs; prototype; recruit; response; scale up; social; success; support tools; therapy adherence; therapy design; treatment program; virology; young adult

ABSTRACT: The scale-up of global antiretroviral therapy (ART) represents an unparalleled global health success story, leading to impressive overall reductions in HIV-related morbidity and mortality. However, adolescents and young adults (AYA), especially those in Sub-Saharan Africa, have largely been left out of this story. While AIDS-related deaths declined by 30% for adults from 2005-2012, they increased by 50% among AYA over the same period, making AIDS the leading cause of death among African youth. AYA living with HIV perform poorly across the entire care continuum. ART adherence is central to effective HIV treatment, but AYA have high rates of virologic failure, virologic rebound after initial suppression, and attrition from HIV care. Unique developmental features of adolescence and young adulthood such as impulsivity, risk-taking, and poor concrete thinking make daily medication adherence even more challenging in this population. In addition, the attitudes and behaviors of young people are often strongly influenced by their peers. This influence can be seen as a powerful incentive for desired behaviors. Much of the literature has focused on financial incentives, which have shown success in promoting health behaviors. There are few data exploring mobile health (mHealth) technologies to exploit social and financial incentives, yet mHealth platforms allow for the delivery of novel behavioral interventions. With the proliferation of mobile phone ownership in Sub-Saharan Africa in general and in Nigeria in particular, such interventions can be delivered where there is greatest need. More than 75% of HIV-infected AYA live in Sub-Saharan Africa, and fully 10% reside in Nigeria. In this proposal, we will adapt an mHealth application, PEERNaija, to leverage both social and financial incentives to improve medication adherence among AYA living with HIV in Nigeria. We will also work with our partners at APIN Public Health in Nigeria to improve capacity to conduct independent mHealth research. The PEERNaija application will feature routine medication reminders, along with individual adherence monitoring with adherence scores, anonymized peer adherence scores (from peers attending the same clinic; social incentive), and a monthly lottery-based prize for youth with the highest adherence scores (financial incentive). To accomplish these aims, we will build on previous collaborations between Vanderbilt and APIN, a multi-site PEPFAR-supported program serving more than 250,000 persons living with HIV in Nigeria. We will engage key stakeholders in the community through focus groups and key informant interviews to guide iterative adaptation of the app. We will recruit a cohort of 50 HIV-infected AYA to pilot the app and assess feasibility, acceptability, adoption, and preliminary efficacy of important clinical measures (including adherence and virologic suppression). The proposed study will provide important preliminary data for the role of mHealth platforms to harness and deliver social and financial incentives to promote adherence efforts, especially for vulnerable youth, and for a larger intervention trial evaluating this app among HIV-infected AYA in Nigeria.

摘要：全球抗逆转录病毒疗法（ART）的扩大代表无与伦比的全球健康 成功的故事，导致与HIV相关的发病率和死亡率的总体降低。然而， 青少年和年轻人（AYA），尤其是撒哈拉以南非洲的青少年，在很大程度上被遗漏了 故事。从2005 - 2012年起，成年人与艾滋病相关的死亡人数下降了30％，但它们中有50％ 同一时期，AYA有助于非洲青年的主要死亡原因。 Aya活着艾滋病毒 在整个护理连续体中的表现不佳。艺术依从性是有效艾滋病毒治疗的核心，但是 初始抑制后的病毒学衰竭率很高，病毒学反弹以及艾滋病毒护理的损耗。 青春期和年轻成年的独特发展特征，例如冲动，冒险和贫困 具体思维使每日药物依从性在这个人群中更具挑战性。另外， 年轻人的态度和行为通常受到同龄人的强烈影响。这种影响可以是 被视为对所需行为的强大动力。许多文献都集中在财务激励措施上， 在促进健康行为方面已经取得了成功。探索移动健康的数据很少 （MHealth）利用社会和经济激励措施的技术，但MHealth平台允许提供 新颖的行为干预措施。随着撒哈拉以南非洲的手机所有权的扩散 尤其是在尼日利亚，可以在最需要的情况下提供此类干预措施。更多的 超过75％的HIV感染的AYA住在撒哈拉以南非洲，完全居住在尼日利亚。在这个建议中，我们 将调整MHealth应用程序Peernaija，以利用社会和经济激励措施来改善 在尼日利亚患艾滋病毒的AYA中的药物依从性。我们还将与Apin的合作伙伴合作 尼日利亚的公共卫生可以提高进行独立MHealth研究的能力。 Peernaija申请将采用常规药物提醒，并遵守个人 以依从性得分进行监测，匿名的同伴依从性得分（来自参加同一诊所的同伴； 社会激励措施），以及依从得分最高的年轻人每月基于彩票的奖项（财务 激励）。为了实现这些目标，我们将建立在范德比尔特和阿皮恩之间的以前合作的基础上 多站点PEPFAR支持的计划为尼日利亚有25万多名艾滋病毒的人提供服务。我们将 通过焦点小组和主要的线人访谈与社区中的主要利益相关者参与，以指导 该应用程序的迭代改编。我们将招募一个由50个HIV感染的AYA组成的队列，以试行该应用程序并评估 重要临床措施的可行性，可接受性，采用和初步疗效（包括依从性 和病毒抑制）。拟议的研究将为MHealth的作用提供重要的初步数据 利用并提供社会和经济激励措施以促进依从性努力，特别是 脆弱的年轻人，以及对尼日利亚HIV感染的AYA中该应用程序进行更大的干预试验。